My 81-yr-old cousin is here permanently

So, I can't recall when I posted about this last, but I finally went up to NYC last month and got my cousin on an airplane (with-her cat--oh, yeah, I posted about the cat!! LOL! Finished my last antibiotic last night).

Just got the MRI report. On top of the broken coccyx (which she fell on twice this wk!!!) she has a compression fracture at L1-L2, a broken and pinned right hip, and spinal stenosis. She is in constant pain.

The dr took her down from 40 mg of oxycodone every 4 hrs, to a time release of oxycodone every 12 hrs. They upped her Cymbalta and antidepressant (What IS the name of it?) which helps a lot ... mostly because they not only mellow her out, but they make her sleepy.

She used to call me 16X a day (I kid you not) and now only calls a cpl times. Yesterday she called because she was in pain and miserable. I have learned to call the nurses' station to ask them what's going on, so I don't go on a wild goose chase (and she has sent me on MANY). The nurse said she did not want to get out of bed and did not want to eat.
Okay. Fine.
If I had that many broken bones, I wouldn't want to, either.
Problem is, if you don't get up, bathe, sit in a wheelchair--pain or not--the eventual issue will be pneumonia and then it's good night--forever. She just doesn't get it.

I am itching to talk to the ortho surgeon, and would like her referred to a neurosurgeon, too. I want a kyphoplasty done on the L1-L2 break, (they say you can't do it on the tailbone), and if that doesn't work, a total, permanent nerve block. She would lose function, but if she has to trade pain and function for quality of life, it's a no-brainer.

Meanwhile, I am trying to get my daughter and sister to fly to NYC with-me in March, during spring break, to close up the apartment (she has been on rent control since the '60s and the landlord is dying to sell it for a million as a condo) and it would be nice if I could fix it up, buy and then sell it, but it's just way beyond my scope right now. My main thing is how to tell her that she's not going home. Ever.

And, what to do with-the cat. I've printed flyers and posted them at local vets, and am debating whether to take her to a local no-kill shelter, to be placed ... somewhere. I just hate to put her down.

I took my cats in today, to visit my cousin. I found a nifty backpack/stroller cat carrier online and it came in the mail yesterday. It's pink. Both of my cats fit in it, albeit a bit squished. They were so cute. They had their paws around one another like they were hugging. (Like they had a choice in that confined space? ) They loved visiting my cousin, and she loved petting them, but soon reverted to begging/demanding pain pills, just after she'd had her oxycodone, and then she fell asleep, so I pulled the kitties out from under the furniture and headed on home, to do her laundry. She wet the bed and the laundry was gross.
Bad enough that difficult child wets his bed. Now I have her laundry, too.
If difficult child were more industrious, he could make some money doing the laundry ...

So, any suggestions for how to break it to my cousin that she's not going home? husband thinks I should hire a dr to do it, so s/he can deflect the anger, anguish and despair.

Don't tell her. Just pull a "Fried Green Tomatoes" on her. When she's done with the hospital, tell her that she needs to be someplace that can offer her PT and assisted living until she can get back on her feet. But given the circumstances, I wouldn't fight this fight until it was inevitable.

O.M.G. what a lovely soul you are. I agree with husband - get a doctor to tell her that she can't go home and then stand back and act surprised. Practice acting - lol. Really she is going to be very angry and resentful and when that comes out? Nelly bar the door. husband is wise.

This is going to be an awful lot for your Aunt to take in. Bed ridden, in pain, loss of quality and quantity of life? Depression is really going to come quick, fast and hard -poor thing. How lucky she is to have a loving niece.

The cat stroller was brilliant!! I'm sure there is someone out there for her cat, but if not? It may be more humane for him if he can't be with her to spend his remaining days at the no-kill shelter. Sometimes someone comes in and just wants the cat no one can tame. He may get lucky.
I got a jogging stroller for LuLu - she prefers to jog along. If I could ride in it and teach her to push me I'd have it made.

I wish you the best my friend. You have some very difficult decisions ahead of you. I don't envy you any of the tasks. It may be a bit easier if you had an Estate sale/auction once you get the things out of her apartment she wants. Tag sales are huge here and bring in far more money than anyone thinks about. You could put the money in her savings or whatever she needs. As far as the man selling her place for a condo? Had you maybe thought about taking it over for your get away place? Hmm???? Maybe he could buy you out? If she's still alive and deeds it to you could that work? Not sure how all that works.

Oh and FYI - Borax and Tide for her sheets and clothes....VERY helpful.
You'll also want to consider (maybe) taking her things to a laundromat instead of washing them in your machines.

You really are getting extra gems in your crown for this. You're a real doll.

Try acting? Bwwhahahahahahaha!!! She was an actress! Like I could pull that one off!
But I have fibbed a bit here and there. Scary, how good I'm getting ... when I know it's in her best interest. (And mine.)

Ah. The cat. She will most likely end up at the no-kill shelter. I'll donate $100 for a yr of her care and then ...

Yes, an estate sale could be a good idea.
I will talk to the landlord about how much it would cost to fix up the place and buy it, but I can guarantee he will want at least a million. It's in Manhattan, within walking distance of everything.
I would love a getaway place ...

So, I think I'll fib for a while longer. Problem is, her handyman/friend/whatever has a huge mouth and he's the one who told the superintendent, who told the owner, who called me last wk... that P may not be coming home.

What happens when I close up the apt and HE tells her over the phone????

You're just getting it cleaned up for her. No worries. Just thought any painting etc. would be easier to do while she isn't home. Plus, she can enjoy the nice new paint/floors/whatever when she gets back home.

Terry, welcome to my world. My mom is 82 and is staying with me. She is talking about going home to Pa when the weather improves in March. Meanwhile the effort of taking a shower even with a shower chair causes her cardiac symptoms. She can not walk without a walker because of her back and spine. She had a fusion and rods inserted years ago but it has just not been able to hold back the deterioration.
I have slowly taken over her "stuff" over the course of 18 months. I do all her banking and even have her mail sent here. We will go to Pa for doctors appointment.

I have realized that issues my mom fought me on like following directions and/or not staying alone were not really computing. I just take care of it and she seems fine. She wants to argue but seems relieved when the decision is taken away from her.
She decided a year ago to forgo the intense cardiac surgery to enjoy a quality of life. She has been doing well but is considered a terminal cardiac case.
I have consistently told my mom that when she is healthier maybe she will return home. We all know she isn't going to be healthier any time soon. I think it's a game she needs not to be swallowed in fear of being homeless. She also knows I won't allow her to be in danger regardless of any other objections. She knows I have her doctors on speed dial and they listen to me. LOL.

I try very hard to give my mother her dignity and ask what she wants and have a discussion. I have medical power of attorney but as long as she has a voice and some semblance of reality, I will abide by her wishes. Asking her if she wants to be resuscitated is not really something she would understand. It would terrify her. Our goal is to treat everything so she is pain free and unafraid but when her heart stops it will not be restarted.

I think being prepared for the inevitable end is important. The goal is a to be comfortable and anxiety free if possible.

Terry, I agree with those who say let the doctor be the one who breaks the news. Thats the way we had to do it with Tony's grandma who actually still had her faculties when she went into a rest home at 90. Oh she was mad! She still blamed us but we kept telling her we didnt have a blasted choice and it was the doctor's and the mean social workers from DSS. In truth it really was. I would have let her live out her life in her home and die there. Long story.

If it would upset her that much, I think I might be trying the "Fried Green Tomatoes" approach too. We sort of had to do that with my mother too who really didn't understand that she had terminal cancer. The doctor explained it all to her and the next day she didn't remember the conversation at all. No way we could have brought her home ... I worked full time, kids were only 5 and 10 years old at the time. It wasn't the best approach but it was all we could do at the time.

Listen to the others! I have watched my mother in law try to gloss over and make everything perfect for her Daddy... lying and "making" things work for him. They let him trade his car in for the cash for clunkers!!! He CAN'T drive! But she was too scared to tell him and would not ask or talk to the Doctor about it...
Now he has these fantasies about how it is going to be..

I know you are not as "dumb" as my mother in law is acting. But it is so easy to feel sorry for them. Let the Doctor be the bad guy.

WHen I was in Physical Therapy, I would have say a hip replacement patient. I would sit with the family (I was the grunt in training!) I would say very loudly and to the patient everything that the family had asked me and that the elderly person had not been doing.
I could be firm with them and lay it out honestly with no family ca-ca.
It was so much easier than the Daughter or Niece having to nag them and then deal with all of the other stuff as well.
I could let them know that the family were the GOOD guys.

Thank you all.
I would love to be the family good guy but P is in so much pain and having so much anxiety that there are no good guys right now.
I had the nurse call the dr today, because all P did was cry, and the dr said No more Ativan, but increase the stool softeners.
Sigh.
husband was there so see almost all of it. He said it's too hard to separate the real pain from the anxiety and drama. We won't know for sure until she has surgery.
Which can't happen soon enough.
Everything takes so long! I hate having to work through channels.

So, I guess I'll do the Fried Green Tomatoes thing after March, and hope that her handyman friend doesn't blow our cover.

I don't know if I could do that for a more distance relative- but then maybe that's because I don't think I could do that much for anyone except difficult child or a partner- but then look at my family. LOL!! Still, you are to be admired for taking this on, especially since you already have your plate full. I hope she's appreciative to you!

As far as the cat, I'm not sure if it would be the same where yyou are bbut here the no-kill places are full and have no more room to house more pets- especially the cats, for some reason. You might have better luck just doing your own advertisement (in the free places- like online) and screen the potential new owners yourself. It's a PITA but it does offer the advantage of the person who knows the best being the one to choose the most appropriate and best-fitting home for it. I'm just basing that on the way things are in this area though- maybe you can find a shelter there that isn't full already.

Terry, I've worked in LTC facilities & nursing homes. I think you cousin should be told only what she needs to know given her other issues.

Make your cousins space as homey as you can; lots & lots of pictures from her life & her loved ones. Plants (if allowed), her favorite candies, etc. At her age she should be allowed what she wants - period.

With all the broken bones I hate the pain medication thing that's going on....dependent or not, this woman is in pain. Prescribe methadone or something of that nature. A patch with continual relief. AND this is my personal opinion.

In the meantime, does you cousin enjoy jigsaw puzzles? Will she play a game of cards? Anything to get her mind off her pain a bit & have some fun. Does this home have activities & has an Occupational Therapist (OT) been in to evaluate her? How about PT? Especially PT with her propensity to fall.

Just some thoughts for you to consider. I know this is a lot for you to take on with your difficult child. We are the generation who needs to care for our kids plus our parents (elderly relatives).

by the way, who is your cousins power of attorney? She should have one for both legal & medical issues.

When I tried to open a joint checking acct the other day, the banker pointed out that my POA expires if my cousin is declared incompetent. I didn't realize the diff between general POA and durable POA. Arrgh. More forms for her to sign!!!

The dr flat-out refuses to give her more pain medications and won't even increase her psychiatric medications. I just don't get it. I am going to call him tomorrow and tell him that you can't teach an old dog new tricks. It's just cruel.

He points out that she was an actress so she is very dramatic. Even the nurses say that.
I understand, and I know all about enabling. But for chr*ssakes, she's 81 and on her way out!!!

In fact, when I put up pics of her when she was young, thinking that the staff would see what she was like, and treat her as a real person, some of the nurses made nice comments, but others made rude comments. She's got a sexy pose where she is facing the camera, on her elbows, with-lots of cleavage, and one nurse asked, "Is that YOU?"
Yes.
"Why did you have your picture taken with-no clothes on?"
I am wearing clothes. It's just a sexy pose.
"I don't know why anyone would want to do that."
And, to her 8X10" glossies, incl her HS grad photo and a 1970's publicity photo, "You must think a lot of yourself to have all these pictures around."

Arrrgh!!!!!

So, instead of thinking of her as a whole person with-an interesting life, they judge her. (I told her, "Welcome to the South.")

I removed two of the photos and replaced them with-smaller photos of my husband and myself. Sigh.

Just to add a wrench to the works, for the first 2 wks, I was very polite and asked nicely if I could have a glass of water from the medication cart they have. They all said, "Oh, help yourself." Yesterday, the Head Nurse told me I can't do that anymore. She said, "We'll give you the water, it's just that we're coming up for a state visit and evaluation and have to get into the habit of doing things by the book. We can't have people coming by and just taking things off the cart."
That's just one example of the way things keep changing. Bedpan, or wheelchair? Or lift?
It all depends upon whether Big Brother is watching.

I am sure that Residential Treatment Center (RTC) and juvie are the same way.

It sounds like they are convinced that she has entitlement issues and they are trying to bring her back down to earth so she can accept the reality of the her destiny...at least that is the way it appears to me.

Terry, don't you just want to stomp on dr.'s foot & then accidentally jab this doctor in the eye as you lose your balance & hit him in the nose; then withhold pain medications. He's being too dramatic.

OMG, I saw this at my grandpa's facility; my mom, sibs & I fought for grandpa (who died @ 97) to have comfort care, not rehab. He'd lived a long full life - rehab was beyond reason.

Sending hugs and support your way. How lucky she is to have such a caring and thoughtful neice.

My family members have never required intensive care so I'm grateful decisions of this magnitude have never been on my plate. husband and I are hoping we will also be spared the downward slope. Many people have told me that the selection of the MD and support staff is really important as some freely dispense medications for pain management and others seem to fear triggering drug dependency. In casual converations I have stressed to my easy child that we don't want to tough it out so choose caregivers very carefully. The lack of respect that you have overheard from staff is just unbelievable. It makes you wonder what they do and say when family members aren't present.

You need to get that durable power of attorney pronto. I was lucky that my moms lawyer was a friend and he really went above and beyond what was technically legal in getting her POA done when it was time. She hadnt had it drawn up and really wasnt in her right mind when I had to come get her but he was well aware that there was absolutely no one else to take on the job. The fact that she had one lucid moment to say that I was her daughter and could give my name, and he filled out the form. She really had no clue what she was actually doing. He knew that but it was essential. Otherwise we would have had to go to court and there simply wasnt time. I needed to be able to take her to doctors and get her moved in record time. He was a good man.

I also had some trouble with some of the nursing home staff not understanding the unique situation with the relationship between my mother and I. By the time she entered the nursing home I had become so emotionally burnt out that I could hardly function around her. I attempted to visit for around 6 to 9 months but then I just almost became in a state of panic when I saw the building. I couldnt make myself go inside. I knew she didnt even know me and she wouldnt know if I was there or not and it was only traumatizing me more. I chose to stay away. The nursing home threatened to call APS on me. I attempted to explain the situation. They didnt care. I went to APS myself and explained the situation to them before the call could be made. They understood. I had done what I was legally responsible to do for her. I was off the hook. When she died, we took care of that expense.

Terry, don't you just want to stomp on dr.'s foot & then accidentally jab this doctor in the eye as you lose your balance & hit him in the nose; then withhold pain medications. He's being too dramatic.

LOL!

I can see that several of you have been through this, or similar situations. Thank you all.I left a msg with-the ortho surgeon's nurse today. The rest of the day I slept. Wasn't planning to waste the day, but difficult child snuck into easy child's bedroom and got on her computer at 11:35 and I heard him. I can't operate on 6 hrs of sleep, so after I took him to school, got a chiro adjustment, and went to the pharmacy, I laid down for a quick nap, and woke up mid-afternoon! Arrgh!